post by Bill Gardner
I recently recommended a podcasted lecture by Dr. Allen Frances, the former chair of the American Psychiatric Association's DSM-IV (Diagnostic & Statistical Manual, version IV) task force, on the problem of over-diagnosis in psychiatry. Dr. Howard Brody has a recent post in which he criticizes a proposed revision of the DSM which would treat grief persisting longer than two weeks as a depressive disorder. He also reports an interesting rumor,
I have heard murmurings that if the APA [American Psychiatric Association] proceeds to issue the new DSM-V (apparently scheduled for next year) with this reclassification [of grief], some of the primary care physician organizations, including my own American Academy of Family Physicians, might vote formally to dissociate their members from DSM. This would be an unprecedented move as up till now, starting at least with DSM-III, all medical specialties have been willing to accept as gospel the disease classification proposed by the APA.
This is one of Frances's primary concerns, that over-diagnosis is damaging the field of psychiatry.
Worse, if Brody is right, the de-legitimization of the DSM may be damaging mental health care generally. Providing effective mental health care to the population requires close cooperation between mental health specialists and primary care clinicians (like family physicians). There are not enough psychiatrists to care for the mentally ill. Some rural areas have no psychiatrists at all. The way to make this work is collaborative care, in which primary care physicians work directly with patients in consultation with a mental health specialist. This will not work if the disciplines cannot agree on a common language to describe cases.
Or it may be that pressure from family physicians and other peers will encourage the APA to reconsider the design of its diagnostic system.